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David Rearick, DO, MBA, CPE, received his DO from Midwestern University, Chicago College of Osteopathic Medicine, and his MBA from Emory University. He is known nationally as an expert in the fields of wellness, benefit design and oversight of care management programs. In addition to his frequent speaking engagements and professional articles, Dr. Rearick has authored Good Health is Good Business-an Implementation Guide for Corporate Wellness (www.wellfitadvantage.com). He is a board certified family physician with 20 years of clinical experience. After leaving 20+years of clinical practice, Dr. Rearick served as medical director for Aetna, as Chief Medical Officer of a national health cost containment company, and currently is the VP of Medical Management for Strategic Benefit Solutions, an Atlanta based health and welfare consulting firm helping organization manage their healthcare costs and productivity by implementing health status improvement strategies. He also serves as medical director to the Benefit Advisors Network, a consortium of 30 health and benefit consultancies and Transparent Systems, a pharmacy benefit management procurement consultancy.

Read transcript of the interview

Dr. Mohammad Al-Ubaydli: Welcome to the Patient Know Best podcast. My name is Mohammad and I am delighted to be here today with Dr. David Rearick. 00:08. Dr. David, could you introduce yourself as we begin the podcast.

Dr. David Rearick: Well, good afternoon Mohammad. It’s nice to be with you. For our listening audience, I guess I would start that my background is like yours, a physician, a family physician and practiced in the States for 20-plus years, and then decided that I wanted to move my practice individuals to corporations and practice really the 00:36 population health management. So I went on and got an MBA, and the last 15 years of my career I have spent really on the insurance consulting side of medicine, being medical director in the Southeast for a while and then currently I am medical director to 30 different benefit brokerage firms throughout the United States, and I help their clients which are primarily employers reduce their healthcare costs by improving the health status of their population, of their workforce.

Al-Ubaydli: Okay then, I was really interested basically to notice that you had created a radio show? It’s on www.goodhealth.businessradiox.com. You had quite a few interesting guests. How has it been going?

Rearick: Well, it’s actually going very well. That is a kind of sidelight that has developed out of our work with corporations, and as you said, the show is called ‘Good Health is Good Business’. It’s a show focused on health as a business competitive advantage, and we have had some great, great guests on our show. People that are experts in the area of health and wellness and productivity. We usually highlight a guest every week as well as review of the weekly wellness news, and usually a wellness tip for any committees that are looking for new activities or tips to run their wellness programs. So thank you for asking.

Al-Ubaydli: What kinds of things have people been able to learn from listening to the radio show? What kinds of things have your guests been able to teach?

Rearick: Well, you know every guest that we have on the show, we do ask a single similar question to every guest, and that is, what is your advice, your best advice to drive engagement of the workforce into a health and wellness culture? It’s interesting on how our guests which are experts in their fields all have a variety of different answers, but I think that our listening audience is taking away some excellent ideas on how to get engagement, because if you don’t get engagement by your workforce, no matter how good your programs is, you’re not going to make a difference in the health status of the population.

Al-Ubaydli: The company that begins to work with you on a wellness program, how do they get engagement? What do you advise them?

Rearick: We normally get engaged actually to manage the companies’ health and wealth or benefits. That would include of course their health insurance, their vision, their dental, their disability, maybe their 401 (k). We manage that entire product portfolio for the companies that engage us.

Healthcare is, of course, about 70% of all of that work. It’s the big guerrilla in the room and when they do engage us, we try to incorporate incentives by a variety of characteristics into the actual benefit plan. So we drive the population to be engaged in a wellness program. Let me give you an example of that.

We may set out for a company and say, if your employees want to have health insurance, you require Mr. Employer that it be mandatory that they complete a health risk appraisal. If they undergo biometric testing, which would be a blood drop from their arm, then they would earn a premium differential on what it cost them out of their paycheck every month for their health insurance.

So by doing those types of things we get a very high percentage of the population engaged in a company’s wellness efforts.

Al-Ubaydli: So just be clear, the biometric test that the employer asked the patient to go through, none of those results go to the employer, they just go back to the employee, and just the act of giving that information to the employee is useful to the employee and to the employer?

(00:05:09)

Rearick: Absolutely, yes. There are certainly federal laws under the statute HIPAA that precludes the employer from getting that information that’s referred to as private healthcare information. So we are usually the keeper of those keys as an outside independent consultant, we manage that process, and we are sure that the employer is HIPAA compliant and does not have access to private healthcare information.

However, the employee does have it. They usually get a private independent report, and we would also coordinate with their disease management company, which could be another outside vendor, to help identify from the results of the health risk assessment and the biometric testing which individuals would be the most appropriate to make an outreach to help them control their diabetes, their heart failure, their asthma, their lifestyle risk factors, i.e., obesity, nutritional deficiencies, lack of exercise, and at least contact the member and try to get them engaged in a program that is available and being paid for by the employer. But the employers themselves do not know anything about the person’s private medical history or even who gets an outreach to and invited to join a disease management program.

Al-Ubaydli: Now it was interesting to me when reading your book that the very first part that begins with just explaining to the employer that the improvement in the employee’s health, obviously it’s good for the employer, but it’s also the employer’s responsibility, because the hospital doesn’t care, even the health insurance company does not have any incentives in improving the employee’s health. It’s only the employer that both has the financial wherewithal to make it happen and the incentives to make it happen. Could you talk us through that?

Rearick: Oh, yes. As you know in the United States healthcare system, we primarily have an employer based system unlike most of Europe and other industrialized nations, but approximately 68% of all people that have insurance, get it from their employer. Because the employer is picking up 75% to 80% of the bill for all medical care, it’s really only the employer who is the actual payer who is incentivized to their population healthier.

In our system in the States, we have very much of a fee-per-service type program for medicine. In other words, the more you do the more you get paid, if you are a provider, i.e., a physician or hospital, an ancillary provider. Unfortunately, that has tendency to drive up our cost, and when you are payer, the employer, that’s not a good thing. So the employer is truly incentivized to control unnecessary utilization of healthcare services and the best way to do that is to get their employee population healthy.

Al-Ubaydli: So as the employer begins to do that, what do you advise them as they begin to work with your company and begin using the services?

Rearick: Well, there is one critical area for any employer who wants to be successful in developing a health and wellness culture within their organization. That single most important factor is Chief Executive Officer buy in. The officers of a company must have a vision of health and wellness, if any program like this is going to be successful.

Without the vision and direction set by upper management, it’s very difficult to get middle management on board. It is certainly difficult to get the plant workers on board, the union on board, the wellness committee forum, the budget approved, and so many other things. So I do believe that vision by the CEO is critical and there has to be a desire for management to want to invest in their human capital, if a program like this is going to be successful.

(00:10:09)

Al-Ubaydli: So, as you watch different employers begin to use your services, what you can learn from watching them do so?

Rearick: Well, I think number one, we have sold programs and implemented programs without the CEO’s approval, and we have seen them for alternate sale. We have also seen employers who wanted to simply offer some type of a gift certificate or a $50 incentive to complete a health risk assessment or complete biometrics, and see those programs suffer because the incentive is large enough to change behavior.

We have seen programs that start well, but lose their steam because they do not run regular wellness programming throughout the year, and only do it during the open enrollment, at time when people choose their benefit program. That’s a critical mistake also. You have to have a regular series of wellness activities and challenges throughout the year, if you are going to change the culture.

And the other thing that we have seen, many employers try to do is rely on an external vendor, a wellness company, a disease management company, to try to change the culture of their own organization, which is never really possible. No external organization can change the culture from the outside of any organization. It has to be changed from the inside.

Al-Ubaydli: Basically if the employer doesn’t take it seriously, then the employees aren’t going to take it seriously.

Rearick: That’s very true. Well put.

Al-Ubaydli: Okay. So what do employees worry about that they did actually have to worry about when they begin these kind of programs?

Rearick: Well, I think the employees worry about the privacy issue. They wonder why my employer is doing this. Are they going to use this information against me for termination or maybe to cut back on workers or lay-offs? The employer often times worries about do I have the internal resources currently and staffing to help support a program like this.

And the CFO worries about, is the investment in time and resources going to give me a pay off. So that’s a whole different topic in its own, but certainly the return on investment on a healthy and productive workforce is far more than the savings that you get in direct medical costs. The real advantage is in the areas of productivity.

Al-Ubaydli: So that’s employees not usually take time off and 13:14. They are working well because they are fit and — they haven’t gotten health problems slowing them down.

Rearick: That’s right. If you have a healthy and productive workforce you should see your absenteeism improve, your presenteeism which is people are actually being at work, they are present but they aren’t very productive. For instance, the person who shows up with a bad flu or with a migraine or is depressed, that’s presenteeism. You should see that improve. And in general you should see your workforce actually turn out more work in the same amount of time.

Al-Ubaydli: And then what about the reveres and what should people worry about that they often cannot do?

Rearick: What should — you mean the employees worry about that they normally don’t.

Al-Ubaydli: Yes, and the employers I guess. Is there something that they don’t think of, that you have to remind them of, so that this works well for everyone?

Rearick: Well, I think you do have to convince them that the real advantages of a healthy and productive workforce is not in the reduction of their healthcare premiums and the reduction in direct medical cost, but in the improvement in productivity.

So that’s an area that does need to be managed and measured. I think employees often times don’t realize what the true benefits of health are. And that the real beneficiary of health is the person who has it, not necessarily the employer.

(00:14:54)

That point is often times, I think, lost on the employee when a program like this is being put into an organization, financed by the organization, paid for by the organization. The real beneficiary is really the member who engages.

Al-Ubaydli: So what kind of tools are useful in setting this type of — obviously I am most interested as to 15:19 tools, but what kind of information management tools help this kind of program be delivered to its best?

Rearick: That’s a great question, because if you don’t have the right tools and you don’t have the right metrics to measure, you don’t manage the process. We are a big fan of what gets measured, gets managed; and what doesn’t get measured, doesn’t get managed well.

So you need data, and the data that you really need to start with is the aggregate data from your health assessment, which is basically normally an online profile that every member completes. That allows an aggregate employer report to Board of Personal Health Care Information that basically outlines what the cost drivers are within the population. What are the issues that the population has? What percentage of smokers, what percentage of people are sedentary? Who has uncontrolled blood pressure, elevating cholesterol? The numbers.

So now you know what your issues are and you can track that. We frequently track the average number of risk factors within a population and the average risk factors per member. Most members have an average risk factor of anywhere between 3 and 4 risk factors per member.

We also track the financial measurements of the per member per month financial cost for medical and pharmacy claims. We also look at the utilization statistics for 1000 members for the major chronic diseases within the population as well as the in-patient days or hospital days for each major chronic disease and the ER visitation rate for each chronic disease.

We also look at the quality of care that the population is receiving. Therefore, if we are looking at the diabetic population, we will be tracking the number of diabetics to get a Hemoglobin A-1c on an annual basis. The percentage of those that are getting their annual eye exam, percentage that are on an ACE or an ARB medication to prevent renal disease, uncontrolled blood pressure.

We will look at the number of diabetics that are admitted. How long their length of stay is? All variety of metrics for the various diseases that are driving the employer’s cost structure.

So that type of report which we produce quarterly and then within annual CFO scorecard gives the employer a real view of what’s going on with its population.

Al-Ubaydli: That’s pretty interesting. And how can they start using that program? Which website should they visit?

Rearick: The best site to go to is our company website which is — our firm is called Strategic Benefit Solutions and our website is sbs-benefits.com, or if they decide to visit our radio show and listen to some of the podcasts on productivity and health, they can go to www.healthybusinessradio.com.

Al-Ubaydli: It’s pretty interesting. I am just adding those links to the podcast. Is there anything else you would like me to have asked you that people need to know about?

Rearick: No. Just pray across in America that we get healthcare reform completed this year and there is something worthwhile.

Al-Ubaydli: We have a whole team who wants to get this done, it would be fine. Okay. Well thanks very much David.